Healthcare Provider Details

I. General information

NPI: 1972982338
Provider Name (Legal Business Name): INDUSTRIAL ON-SITE NETWORK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2015
Last Update Date: 05/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4902 S VAL VISTA DR SUITE B102
GILBERT AZ
85298-7325
US

IV. Provider business mailing address

4902 S VAL VISTA DR SUITE B102
GILBERT AZ
85298-7325
US

V. Phone/Fax

Practice location:
  • Phone: 480-855-8866
  • Fax: 480-855-8867
Mailing address:
  • Phone: 480-855-8866
  • Fax: 480-855-8867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: ALLISON SAMIA
Title or Position: BUSINESS MANAGER
Credential:
Phone: 480-855-8866